The Profession of Nursing: Roles, Education, and Regulation
The history of nursing practice is a testament to the profession's evolution from ancient informal caregiving to the specialized, evidence-based practice it is today. Today, nursing is recognized as a vital component of the healthcare system, with over 29 million nurses globally. In Washington State, the term “nurse” has a specific legal definition that defines the requirements of a licensed professional.
In Washington State the term “nurse” has a legal definition that defines the requirements of the licensed nurse. In fact, there are 6 legally defined nursing related roles for the person caring for you or a loved one in a medical setting.
HCA Health Care Assistant
MA Medical Assistant
CNA Certified Nursing Assistant
LPN Licensed Practical Nurse
RN Registered Nurse
ARNP (soon to change to APRN) Advanced Registered Nurse Practitioner (Advanced Practice Registered Nurse); Typically NP or Nurse Practitioner.
Let’s look at the following example of each role in operation.
You were asked to accompany your mother from the nursing home to the clinic to be seen for a rash. You arrived to pick her up from the nursing home and are greeted by the CNA caring for her that day. Before you leave, the LPN stops by with your mother’s morning medications. You arrive at the clinic and are led to a room by the MA who obtains her vitals. She is seen by the ARNP (NP) who evaluates, diagnoses and makes a plan for her rash. On the way out of the clinic you are greeted by your aunt who resides in an adult family home. She is brought to the clinic by the HCA caring for her. When you return to your home you see the RN' working with hospice, coming to visit your neighbor who is dying of cancer.
Detailed Nursing Roles and Pathways
1. Healthcare Assistant (HCA)
An HCA provides essential personal care and support to patients, helping with daily activities like bathing, dressing, and eating, while also assisting nurses and other medical staff in various settings like hospitals, clinics, or homes; requirements often include a high school diploma, specific training, and background checks, with roles focused on patient comfort, vital sign monitoring, and administrative tasks, making them crucial for direct patient support.
What They Do: They assist with bathing, grooming, dressing, toileting, and feeding. They also prepare meals, perform light housekeeping, take vital signs, and provide social engagement and emotional support.
Where They Work: Hospitals, nursing homes, assisted living facilities, clinics, and patient homes.
How to Become One: Requires a high school diploma or GED and completion of approved training programs, including a 75-hour requirement in Washington State.
2. Medical Assistant (MA)
An MA performs both administrative (scheduling, records, billing) and clinical (vitals, drawing blood, assisting doctors) tasks in healthcare settings like doctor's offices, growing in demand due to an aging population. Entry typically requires postsecondary education (certificate/diploma), leading to roles in a fast-growing field with projected job growth and a median salary of around $44,200 (as of May 2024).
What They Do: Administrative tasks include scheduling, managing records, and billing. Clinical tasks include taking vital signs, recording histories, drawing blood, giving injections or medications as directed, assisting during exams, and performing EKGs.
Where They Work: Most commonly in physicians' offices, but also in hospitals, urgent care, and dental offices.
How to Become One: Requires a high school diploma plus a certificate/diploma program (less than a year) or an Associate’s degree (2 years). Washington requires passing the WA Medical Assisting Exam.
Job Outlook & Pay: Projected much faster growth than other positions (12% from 2024-2034), with many openings from retirements. Median wage was $44,200 in May 2024.
3. Certified Nursing Assistant (CNA/NA-C)
CNAs or Nursing Assistant -Certified (NA-C) provides essential direct patient care, assisting with daily living activities like bathing, dressing, feeding, and mobility, while also monitoring vital signs and reporting changes to nurses, working under RN/LPN supervision in settings like hospitals or nursing homes after completing a state-approved training program and passing a certification exam. Becoming a CNA involves a short, state-approved course (around 4-8 weeks) and passing exams, making it an entry point into healthcare.
What They Do: They assist with bathing, grooming, dressing, feeding, and mobility. They also monitor vital signs and act as the "eyes and ears" for the clinical team by notifying nurses of condition changes.
Where They Work: Primarily in nursing care facilities (35%) and hospitals (33%).
How to Become One: Involves a short, state-approved course (4–8 weeks), 130 hours of coursework, 30 hours of clinical training, and passing a state certification exam.
4. Licensed Practical Nurse (LPN/LVN)
LPNs or Licensed Vocational Nurse (LVN) in some states, provides basic patient care like taking vital signs, administering medications, and assisting with daily needs, working under Registered Nurses (RNs) and doctors in settings from hospitals to nursing homes. Becoming an LPN requires completing a state-approved practical nursing program (about a year) and passing the National Council Licensure Examination (NCLEX-PN) exam to get licensed. LPN roles are crucial for patient comfort, safety, and monitoring, with strong demand due to an aging population.
Responsibilities: Monitoring vitals, administering prescribed medications and injections, changing bandages, treating wounds, and documenting patient care.
Where They Work: Nursing and residential care facilities are the largest employers, followed by hospitals and home healthcare.
How to Become One: Requires a high school diploma or GED, completion of a state-approved practical nursing program (typically 1–2 years), and passing the NCLEX-PN exam.
Job Outlook & Salary: Projected growth of around 3% from 2024-2034 with a median salary around $62,340 annually (2025 data), with variations by location and experience, according to the Bureau of Labor Statistics.
5. Registered Nurse (RN)
An RN is a licensed healthcare professional who has completed an approved nursing program (associate's degree, bachelor's degree, or diploma) and passed the required national and state examinations to provide and coordinate patient care.
Core Responsibilities: Performing physical exams, recording medical histories, administering medications, developing and implementing nursing care plans, and coordinating care with specialists like physical therapists and pharmacists. They also advocate for patient rights.
Education and Licensing: Requires a nursing diploma, Associate Degree in Nursing (ADN), or a Bachelor of Science in Nursing (BSN). Candidates must pass the NCLEX-RN exam.
6. Nurse Practitioner (NP/APRN)
An NP is an advanced practice registered nurse (APRN) with graduate-level education (master's or doctoral degree) and clinical experience who is qualified to provide a broad range of healthcare services, often with a focus on holistic and patient-centered care.
Core Responsibilities: NPs possess greater autonomy and can perform many duties traditionally associated with physicians. This includes diagnosing and treating acute and chronic conditions, ordering and interpreting lab results, and prescribing medications.
Education and Licensing: Candidates must complete a Master's or Doctoral level education in a specialty area, pass a national exam, and be licensed by the state board.
Education in Okanogan County
Nursing education has evolved from hospital-based repetitive practice to modern programs emphasizing the scientific basis for nursing actions.
In Okanogan County, education began in the 1970s with an LPN program through Wenatchee Valley College (WVC) in Omak. By 1986, the program added an Associate Degree in Nursing (ADN), and students can now earn a Bachelor's of Science in Nursing (BSN) locally. Roughly half of the nurses working in Okanogan County are graduates of the WVC program. North Valley Hospital, like other facilities in the county, typically hires nurses upon graduation from this program.
The recently launched Rural Nurse Education Program (RNEP) creates a new pathway for students to study online and complete their clinical rotations at their host organization.
Governance and Regulation
Nursing practice is regulated at the state level by Boards of Nursing (BONs) through Nurse Practice Acts (NPAs). In Washington State, the regulatory board is the Washington State Nursing Care Quality Assurance Commission (NCQAC).
RCWs (Revised Code of Washington): Statutes written by the Legislature and signed into law. RCW 18.79 covers the scope of practice, delegation, and licensing for RNs, LPNs, ARNPs, and nurse techs.
WACs (Washington Administrative Code): Rules that provide interpretive support for RCWs and carry the full force of law. WACs are made for nurses, by nurses, allowing for specific details regarding nursing care and public feedback outside of the legislative session.